MEDICARE: BACK TO WOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC 10096	PA

General Provider Information

NPI Number	:	1558638569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO WOW

Provider Business Mailing Address
First Line	:	2106 SPRING VALLEY RD
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-2427
Country	:	US
Telephone Number	:	717-517-8960
Fax Number	:	717-431-6649

Provider Business Practice Location Address
First Line	:	2106 SPRING VALLEY RD
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-2427
Country	:	US
Telephone Number	:	717-517-8960
Fax Number	:	717-431-6649

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KYLIE J LOMBARDO
Credential	:
Telephone Number	:	717-517-8960

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	08/27/2012

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Directions to “BACK TO WOW ” Practice Location

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